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Pediatric Cervical Spine. X-ray Rounds, Phil Ukrainetz, MD, PGY5 December 5, 2002. “Normal anatomy”. C-spine ABC’s Corresponding anatomy Pseudosubluxation Positioning. C-spine ABC’s. Alignment Bone Cartilage Soft tissue. C-spine ABC’s. C-spine ABC’s. Anatomy. Pseudosubluxation.

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pediatric cervical spine

Pediatric Cervical Spine

X-ray Rounds, Phil Ukrainetz, MD, PGY5

December 5, 2002

normal anatomy
“Normal anatomy”
  • C-spine ABC’s
  • Corresponding anatomy
  • Pseudosubluxation
  • Positioning
c spine abc s
C-spine ABC’s
  • Alignment
  • Bone
  • Cartilage
  • Soft tissue
pseudosubluxation
Pseudosubluxation
  • Physiologic anterior translation of C2 on C3 in children
  • Seen in 25% of children < 8 yoa
  • May be seen up to 16 yoa
  • Seen in up to 1/3 of all pediatric neck films
why do they pseudosublux
Why do they pseudosublux?
  • Horizontal facets
  • Weak neck musculature
  • Cartilage artifact
  • Ligamentous laxity
  • Increased with neck flexion
causes of anterior translation of c2 on c3 in children
Causes of anterior translation of C2 on C3 in children
  • Pseudosubluxation
  • Hangman’s fracture
swischuk line
Swischuk line
  • Posterior cervical line
  • “Draw from C1 posterior arch to the cortex of the posterior cortex of C3 arch”
  • Line should pass through or be less than 1 mm anterior to the posterior arch of C2
      • Swischuk LE. Radiology 1977; 122: 759-763
problem s with swischuk line
Problem’s with Swischuk Line
  • We see normal Swischuk line with hangman’s fractures - not sensitive or positive in disease
  • We see abnormal Swischuk line with normal necks in flexion - not specific or negative in health
  • A value >1.5 -2mm suggests an occult hangman’s fracture
        • Woodward GA, Neck Trauma, Fleisher/Text Ped Emerg Med, Fourth Ed. 2000, pp 1327
in swischuk s words
In Swischuk’s words..
  • “The posterior cervical line should only be applied when C2 is displaced anteriorly on C3”
positioning
Positioning
  • Huge cranium
  • Exhalation
  • Neck spasm flexion
summary
Summary
  • Swischuk line is a diagnostic adjunct
  • Consider pre-test probability
  • Consider concordance with tests
  • Low likelihood of injury and abnormal film - consider repositioning/disregard
  • High likelihood of injury and normal film - continue investigating
unstable c spine fractures
Unstable C-spine fractures
  • Jefferson (C1 burst)
  • Bit (Bilateral facets)
  • Off (Odontoid)
  • A (Any fracture dislocation)
  • Hangman’s (C2 pedicle fracture)
  • Tit (Flexion/Extension teardrop)